Profits over your dead body

Health regulatory and advocacy groups are deliberately corrupted.

Imagine living in a world where visiting the doctor was an experience fraught with danger. Where the drugs you were prescribed may or may not be effective—and may or may not be safe. Imagine having a medical procedure recommended that wasn't known to work.

Up until the beginning of the 20th century, that was the case. People feared doctors, and rightly so, as bringers of death. But now, medicines and medical practice are tightly regulated, and a visit to the doctor is unlikely to result in septicaemia, or some other -emia that results in green goo bursting out of a limb. Nevertheless, certain practices have crept into healthcare that, on aggregate, have led to the early deaths of large numbers of people.

Now, the conspiracy minded among you might be thinking of cartoon villains covering up dastardly poison pills, but this is not actually the case. Ben Goldacre, a physician who writes the Bad Science blog, has now made a comprehensive catalog of these practices published in a book called Bad Pharma. In examining the healthcare industry, he paints a complicated picture in which almost all the actors are both bad guys and good guys. It can be read as a stinging rebuke, but more than anything it's criticism from someone who appreciates everything modern medicine has done—but wants to see it do even better.

Your GP is your friend, right?

Goldacre takes the medical community apart piece by piece. Take, for example, your friendly general practitioner. How old are they? When did they leave medical school? How up to date is their medical knowledge? Typically, a doctor's continuing education is an ad hoc thing, until recently, driven by their own motivation to stay current. Now, let's compound the problem: as a doctor, you are offered this very expensive week-long course on, say, the latest in blood pressure control medication. Alternately you can go on a free course. It just so happens that the free course is funded by a drug company, and guess whose drugs take center stage at that course?

Most GPs will take the free course. From the time your GP leaves medical school, they are likely to be given biased information on the effectiveness of drugs, making it difficult for them to make good clinical decisions. And, demonstrating a wonderful lack of self-awareness, most will insist that these sponsored courses and visits by drug representatives do not influence their own prescribing decisions. Even funnier, they do believe that the events influence the doctor next door.

But drugs work, don't they?

Surely the drugs on the market have been shown to work, you cry. Unfortunately, the story is not so simple, and Bad Pharma explains why. To get a drug on the market, you only have to show that it is better than a placebo. Drugs are almost never compared against the current best treatment. And when you do make such a comparison, it can sometimes seem like it is pretty close to random chance that decides whether the older or newer treatment is more effective.

To ensure that their drug makes it on to the market, drug companies can run multiple trials, and then simply present the data from the trial that shows a positive result—the rest never sees the light of day. Well, okay, it is not quite that simple, but it is true that negative results aren't put forward for public scrutiny, and that drug companies have a history of misleading regulatory authorities with trial data. The companies work to ensure that a drug stays on the market for as long as its patent is valid.

It is even worse than that though. Often you want to know whether the drug treats the underlying condition. But that can be very difficult to measure, so we end up using proxies. For instance, if you are treating a heart condition, then what you want to measure is whether the drug extends the life of the patient. But that takes years to test so a proxy like blood pressure is substituted. If a treatment lowers blood pressure, it must be doing good. That conclusion, however, should be regarded as tentative. To make certain that a drug actually works, those long-term mortality studies must be conducted.

That means that the drugs that you are prescribed are usually not known to be the best treatment. Some may be, but others are, at best, better than doing nothing. Bad enough? Wait, because Goldacre has more. The other side of the coin are a drug's side effects. Before a drug goes on the market, it get tested in up to a few thousand people. This is actually not enough to detect side effects that are either rare, or common within sub-populations.

This comes as no surprise to many people. The problem, however, lies in the lack of follow-through. Often a drug is allowed on the market under the condition that there will be follow up studies that will examine side effects and confirm its effectiveness. Yet those studies are likely to vanish without trace. Indeed, even though medical journals now explicitly welcome negative findings, studies that find a treatment doesn't work are about five times less likely to be published.

This publication bias is important. Imagine that you were a doctor who kept up to date by reading the medical literature—as every good doctor should. No doctor, however, can read all the literature, so they are likely to read systematic reviews, like those offered by Cochrane. However, a systematic review is only as good as the data the reviewers can get hold of—and, as we've just said, that's distorted.

The regulator knows what's best

Amazingly enough, regulatory bodies often have information on safety and efficacy they do not share with the likes of Cochrane. Indeed, they are just as likely to keep the results of studies secret. The European regulatory authority withheld data for a set of drugs for several years on spurious grounds, before getting smacked down by its ombudsman.

It is truly shocking that such poor behavior is simply accepted as normal. The authorities are the only people who can compel a drug company to release data, yet they often don't—and if they won't do it, you can imagine that the drug companies won't volunteer it.

The unhappy situation, according to Goldacre, is that the regulators in the US and Europe have been captured by the pharmaceutical industry. Which is not to say that they don't do their job in determining if a drug should go on to the market. But they have become extremely reluctant to take a drug off the market when it has been found to be harmful or not beneficial.

One of the issues that makes this possible is that the same body of people that makes the decision to allow a drug onto the market is the one that must take it off. Essentially, they have to admit that they are wrong. You try standing up in front of 300 million people and saying "Yeah, sorry that painkiller you have been taking and believe is fantastic? It could give you a heart attack and you aren't going to be able to purchase it anymore."

Patients with no patience

You might think that patient advocacy groups would remain your friend—surely the asthma society will advocate on behalf of asthma patients, right? But as Goldacre describes it, not necessarily. Patient advocacy groups also receive money from pharmaceutical companies, though they never declare this as explicitly as they do the donations from generous individuals or charity fundraisers.

It seems that there is sometimes a correlation between a patient advocacy group's position on a drug and its source of funding. If that is a coincidence, then I am in for some serious hat eating.

There is also the other side of this coin as well, where patients turn up demanding that insurance companies or national health providers fund a particular medication, even though the evidence for the medication's effectiveness might be extremely weak. Yet these patients seem driven to believe that this is the drug they need. The patients seem to get access to major newspapers and television programs, spurring these people on. Almost like the patients had PR agents.

And, as if that weren't enough

Then, of course, there is advertising. Drug companies love to complain about the cost of R&D. Yet advertising costs contribute more to the cost of a pill than R&D. That advertising gets combined with constant visits from drug company representatives, paid speaking engagements, free conference attendance, and sponsored workshops. Let's just say that the industry thinks it money well spent.

But advertising in the healthcare industry should not be thought of in the same way as car or computer advertising. When you get right down to it, buying the wrong computer is unlikely to shorten your life. Treatment decisions truly effect quality and length of life. Doctors and patients need accurate and complete information about a treatment to make an informed decision.

If complete information were available, then doctors would have a much better sense of which treatments were most effective and what their side effects were. And, in this ideal world, treatment would take the patient into consideration. For instance, the most effective drug might have an elevated risk of heart attack—acceptable for a young fit person, but not for someone who already has heart problems—meaning that a slightly less effective drug might be safer for some.

Medical advertising is, in fact, aimed at subverting these sorts of informed decisions. Drug companies want their drug prescribed, independent of whether it actually works or not.

I know, this is obvious, and is the purpose of advertising. But this is advertising that you pay for in several ways. It increases the cost of medical insurance, because doctors prescribe more expensive and less effective treatments. It increases the cost of drugs directly, since that advertising has to be paid for. Most importantly, treatment decisions driven by advertising will sometimes reduce the length and quality of your life.

Nothing to see here, move along

The pharmaceutical industry will try to tell you that these problems are problems of the past. For example, there is now a clinical trial database that ensures that each trial is known about, so that it is possible to infer negative results based on the lack of publication. Indeed, several major medical journals have publicly stated that they will not publish results from clinical trials that haven't been registered. Yet, Goldacre reports that some 20 percent of trials published in these journals in 2010 (after the database was up and running and the agreement made) were not on the register: journals are not doing due diligence.

And in the ultimate dose of fail, there is no one group responsible for curating these databases. So, yes, most trials are registered, but no one checks to see if they have reported back. I think that might be referred to as hiding failure in plain sight.

On publishing Bad Pharma, Ben Goldacre wisely included an afterword in which he tried to anticipate how industry groups would respond. I must say that he has, sadly, anticipated them well. Industry associations have been particularly Orwellian in this regard, claiming that the failed attempts to fix these problems—the failures are documented in the book itself—have, in fact, worked. It is as if they only read the chapter headings and then grabbed a set of scripted responses without checking to see if anyone else had read and anticipated the script.

I guess, for them, this is an attack on the industry as a whole. Which it is, but it is an attack made by someone who deeply appreciates all the good that modern medicine has done, and wants it to get better. Goldacre is not a conspiracy minded nutcase who sees bad guys behind every garbage can. No, he sees a system that has, despite some really perverse incentives, produced some blindingly good products. But those incentives also allow life-threateningly poor decisions to be rewarded, and that needs to change.

Goldacre's encouraging outlook is why each chapter ends with a list of what you, personally, can do to help. Questions you can ask your doctor if you are a patient. Things you can do as a doctor. What academics can do, what pharmaceutical companies can do.

Read this book. It will make you mad, it will make you scared. And, hopefully, it will bring about some change.

169 Reader Comments

The problem, as always with any industry, is money. I guess to clarify that's not entirely true. Industries need money to operate, and the medical industry does indeed need a large amount of money for things like R&D given the breadth of the problems it seeks to solve.

I guess what I should say is the problem, as always with any industry, is money when there are shareholders involved. "The greater good" are just dollar signs in the eyes of the shareholders, so of course shortcuts will be taken and corruption will happen because to the healthy it's the money that is more important than the greater good.

This is just another demonstration of corrupt America. Corporate America (Pharma companies, Big Media, Oil Companies, Wall Street etc) has bribed politicians so effectively that these kind of practices are legal, and will never be investigated because the companies have the people with the power to investigate them firmly in their pocket.

In the UK this practise is banned. About the most doctors can get from pharma companies over here is a branded notepad. Just as in the UK bribing.....errr.... donating funds to politicians in return for favours, is banned.

In the UK this practise is banned. About the most doctors can get from pharma companies over here is a branded notepad. Just as in the UK bribing.....errr.... donating funds to politicians in return for favours, is banned.

There is still a big problem in the UK. The free courses for doctors, regulators hiding data, etc. Fortunately we don't have advertising directed straight at patients but it would be wrong to be complacent and say everything was anything like ok.

There are US specific problems, particularly around advertising and Medicare Part D and obscene profit-taking.

Tax the rich appropriately, as we did in the 50s and 60s, and you lessen the incentive for purely greedy behavior - of course it will always be with us, but we can do more to mitigate it. Tax profits higher on every corporation and the money will be spent in this case on better drugs, better institutions and middle class employees rather than getting awarded to stockholders constantly. It's hard to focus on employees that actually invent your drugs and the patients that buy your drugs when all you have are billionaires screaming in your ears for more money, and when you can keep all the profit you want with obscenely low tax rates.

Look at how Viagra was covered by insurers and spread through the land to rich parties and then think about how hard it is to get quality family practitioners. Our incentives are all wrong, no one has addressed this in years, and the Republicans want to make it worse to benefit their benefactors. No one has talked about Med Part D reform, despite the fact that it contributes to the deficit as the gov't is meaningfully overcharged in a 'free market' arrangement. And the Boehner cartel still rules with false piety and the Democrats still compromise with evil.

I read bad science a few months ago and am surprised how often something from it will come up in an every day conversation. Bad Pharma is definitely on my to-read list, thanks for the excellent reminder.

Yeah, this not a US only problem. The book details problems in the US, UK, and continental Europe

With the same level?

All of them are level 18 Druids. The thing is, it is difficult to compare across countries. For instance, in Europe the regulator is very very secretive, while in the US that is less of problem. In the UK, medicines tend to be cheaper thanks to a number of policies, but the drug companies still influence prescribing decisions to maximize the uptake of branded drugs. In the US, direct to patient advertising introduces a new set of pressures on the doctor, but, it should be noted that pharma spends far more on influence with doctors than it does on patients.

Here's the interesting thing about all these "bad actors". Whatever system their behavior creates, they ultimately live under as well. Or are we saying that bad pharm employees have better doctors, hospitals, and medicines?

Yeah, this not a US only problem. The book details problems in the US, UK, and continental Europe

The few people who profit from these malpractices the better. Universal healthcare is the way to go if we're going to rein in the wild west of healthcare in the US.

Universal Healthcare won't really help this problem (it will help others, create new problems - as usual). The underlying issue is unconstrained greed and regulatory capture. Unconstrained greed can only be limited, never eradicated and is best done with a layered approach of checks and balances.

But you first have to get rid of regulatory capture before the checks and balances will do anything significant.

And while you're at it, remove hubris, sloth and a couple of other canonical sins and we're golden.

Direct-to-consumer advertising needs to end. If you have a condition, you should seek out a Doctor, not a paid spokeswoman for some pharmaceutical company trying to instill hypochondria in listeners. This should go a long way in reducing drug costs, and saving lives by preventing the unnecessary exposure to dangerous experimental drugs.

Furthermore, drug companies should know the scourge they unleash on a population with prescription drugs like Oxycodone. They already made cheap opium illegal, so people have to resort to using an even more dangerous form from bad Doctors who are more than willing to hand them out. Regardless of the insane pill count as it relates to the number of patients with pain, I find that the companies producing these are just as culpable of negligence.

Whilst generally sympathetic to the author's point of view, in many cases the idea of a single best medication for a particular disease is an illusory one. For individuals, there may well be a best medication for disease X, but this varies from person to person, and possibly from time to time, and at present we do not really know enough about the pharmacogenomics of individuals to find this best medication, other than by trial and error. This was alluded to in the review, as an occasional problem but in fact it is probably almost always the case, and is a major, highly valid, reason for keeping allegedly inferior medications on the market. If the statistically best medication for your condition makes you break out in hives, no amount of reading the statistics is going to make the hives go away. However, you may get no hives, but have a poor therapeutic response to the second best medication, and do very well in all aspects on the third best, which for you is the clear #1 choice, even if that may only be true for 10% or less of the population. One day we may have the knowledge to allow us to accurately predict patient responses, but at present, we need an open mind, and an understanding that in many cases trial and error experimentation is still the best way forward. Almost certainly, virtually every drug removed from the market was the safest and most efficacious agent for some subpopulation, but may well have been between dangerous, and highly dangerous in certain other subpopulations. Or, more problematic still, when dosed with certain other drugs, herbs or even foods. Baychol might well have been removed from the market at some point due to rhabdomyelosis as a single agent, if it had become clear its risk was greater than that of the other marketed statins, but when given in combination with lopid, also a dyslipidemia drug, it is estimated that the rhabdomyelosis risk on high dose of both was multiplied over 100-fold, although lopid had no risk for this toxicity as a single agent.

I recently spoke with a friend of about my years, and we are both on statins. He found as years went by leg pains increased on atorvastatin, and so he switched to pravastatin, which still caused leg pain, and did not maintain his favorable lipid profile, and so he switched again to simvastatin, and now has good cholesterol, and no leg pains. I had to switch from simvastatin to atorvastatin, purely to avoid the muscle aches in my legs.

I registered just to say this to you, and that you speak truth which needs to be widely heard.

My husband died of Lymphoma/Leukemia 2.5 years ago, too young. The entire BMT experience and after-care in particular was like a tragic farce. I could unleash a torrent of criticism about the healthcare industry and our experience but I won't. Your article is the best thing I've read in a long time. Thank you.

This is just another demonstration of corrupt America. Corporate America (Pharma companies, Big Media, Oil Companies, Wall Street etc) has bribed politicians so effectively that these kind of practices are legal, and will never be investigated because the companies have the people with the power to investigate them firmly in their pocket.

In the UK this practise is banned. About the most doctors can get from pharma companies over here is a branded notepad. Just as in the UK bribing.....errr.... donating funds to politicians in return for favours, is banned.

Yes, that's why the problem is in Europe as well. Don't blame this all on Americans.

Goldacre's book is, in my opinion, quite misleading. He is correct in saying that the published literature on any drug will be incomplete, as unsuccesful trials often are not published.

He does not explain, though, that the trials which are needed for approval are agreed in advance with the regulator. There is no question of cherry-picking.

It is also not possible, as Goldacre suggests, for a drug company to choose to test its drug against placebo, when effective treatments already exist. The regulator and ethics committes decide on the design of trials and will not allow this.

This is just a symptom of the problem in the US. The health care system is broken from its foundation. The only real solution is to implement universal health care.

No, the real problem is this concept of voting shareholders. If the shareholders can't threaten management with termination, if they don't get enough money from the stock, most of the problems go away. If the public wants to invest in a company, fine. They should have no say in how the company is run. If they don't like the results, they can sell the stock and buy another. Giving stockholders control of a company is the worst thing that ever happened to our economy. Most of the stockholders haven't the first foggy clue about how the company should run. They only care about the value of the stock and how much dividend they get. Not good!

The key to good medical care in my opinion is to challenge your doctor's advice. Say fine: why do you want me to do this. Ask give me two alternatives and tell me why this would be more effective. Ask him or her what statistical reduction of risk the plan of treatment will create. If they cannot answer those questions then you say, please provide me with data, after all this is my health we are talking about.

Honestly if they can't rattle off 3 choices for a common condition then they aren't a very good doctor. There are massive profits to be made there is almost always competition. I never take any medicine without first looking up its chemical structure and as much as I can about how it functions.

Being minted an MD does not make you a god, some behave that way. Those are the doctors I don't go back to.

I've sadly had way too much experience with the medical establishment.

I agree with SunnyD, medicine is a business and follows the money. I don´t know the solution to this either, doctors need to earn money, not a problem with that, but if the whole health industry is a business, its based on the principle of money, not health. Then we have a huge problem.

There are gazillions of cases worldwide of doctors operating someone when they have absolutely nothing. They cut, remove some tissue, and cash the register. The patient was not even aware that he was operated just for pure profits. This is extreme, but it happens every single day.

The pharma industry is even worst. They invest heavily in lobby, donations, advertising and even bribery, to pass their products. Even if most of them do more harm than good. Nobody regulates them, because nobody except the pharma industry itself has the resources to do all the test and trials, and like the article explains they usually never show the downside of a specific medicine.

In an ideal world, medicines and health should be free or at least priced the same for everyone. It should not be a business. Some things work better as a business, some not. Politics, health, are one of them and today everything is a business. Nothing wrong with that, but lets not forget that business are in the game for making money. And again there is nothing wrong with making money. The problem is that the line is very thin when making money is based faith like religion or health where people suffer and will just cash anything in order to be healthy again. Some doctors are the most terrible persons in the world. Not lawyers, but doctors, that use the suffering of people to make themselves rich.

why? it's not really any different than advertising any other publicly available product. prescription drug ads, on the other hand, are terrible because most of the time they don't even say what the drug does.

To get a drug on the market, you only have to show that it is better than a placebo. Drugs are almost never compared against the current best treatment.

Are you sure this is true? My university has a very excellent course on drug design and discovery and we definitely learned in it that drugs are typically compared against the current standard-of-care, not a placebo. This course has weekly experts from major drug companies giving lectures, too, so it's not just some academics spouting stuff they don't know anything about.

This is just another demonstration of corrupt America. Corporate America (Pharma companies, Big Media, Oil Companies, Wall Street etc) has bribed politicians so effectively that these kind of practices are legal, and will never be investigated because the companies have the people with the power to investigate them firmly in their pocket.

In the UK this practise is banned. About the most doctors can get from pharma companies over here is a branded notepad. Just as in the UK bribing.....errr.... donating funds to politicians in return for favours, is banned.

Yes, that's why the problem is in Europe as well. Don't blame this all on Americans.

I agree, donations to politicians in the US are nothing more than legal bribery, and its banned in allot of countries because its basically like you said "bribing"

This is no different than making a live cash donation to a police officer when you are stopped.

What you mentioned is actually not a US problem, its a worldwide problem. Its not banned for pharma to pay doctors, they even receive commissions on some products, so they tend to suggest the most expensive ones.

This is just another demonstration of corrupt America. Corporate America (Pharma companies, Big Media, Oil Companies, Wall Street etc) has bribed politicians so effectively that these kind of practices are legal, and will never be investigated because the companies have the people with the power to investigate them firmly in their pocket.

In the UK this practise is banned. About the most doctors can get from pharma companies over here is a branded notepad. Just as in the UK bribing.....errr.... donating funds to politicians in return for favours, is banned.

I know for a fact that my local Doctors surgery and local pharmacies make a fortune on dishing out Methadone, its a real problem up here in Scotland where doctors can make millions by prescribing it, the NHS subsidises both chemists and doctors to administer and prescribe the stuff.At my local surgery I need to wait on average 12days for a doctors appointment, "recovering" heroin addicts see an average wait time of 24hrs, simply because its money in the bank, working tax payers be damned!

A friend works in a local chemist and has stated that for every methadone client the chemist gets around £2.50 for dosing it out and £1.50 for supervising its consumption on the premises per dose, per client, some clients are in as much as 4x a day!

I don't expect this is a problem that's localised to Scotland either, id be extremely surprised if it wasn't similar throughout the UK.

Look at how Viagra was covered by insurers and spread through the land to rich parties and then think about how hard it is to get quality family practitioners.

It's always going to be that way, most diseases/ailments that are deadly aren't that common, if they were then we'd have been wiped out by now. Cancer is the only major one where there's a whole lot of people who would pay up for a cure (and pay a lot for it), but that's generally speaking, take a rare kind of leukemia that occurs in kids and you don't really have a huge market, so where's the incentive to research it?

At the same time, I'm not sure the government would do much better. The greater good is in things like Viagra. It fixed a problem for millions of people, it was actually an amazing social breakthrough, the kind of thing a government would love to do to support the reason why they spend billions on research. The only difference would be that they hopefully wouldn't spend billions more trying to come up with a competitor, but the difference between a cash cow and something that helps win elections isn't all that far apart, really.

I agree, donations to politicians in the US are nothing more than legal bribery, and its banned in allot of countries because its basically like you said "bribing"

This is no different than making a live cash donation to a police officer when you are stopped.

What you mentioned is actually not a US problem, its a worldwide problem. Its not banned for pharma to pay doctors, they even receive commissions on some products, so they tend to suggest the most expensive ones.

Which includes the issues of patents. Pharmaceutical companies will push doctors towards newer, more expensive, drugs that are still under their patents, even if they are actually LESS effective then an older drug with an expired patent.

Health care is a common good issue. We the people should be funding and benefitting from research of drugs and medical technology. Capitalism isn't up to the task.

Are we so sure that politics is up to the task?

Quote:

I agree, donations to politicians in the US are nothing more than legal bribery, and its banned in allot of countries because its basically like you said "bribing"

It's highly restricted in the U.S. as well. It's a myth that corporations - or anyone - can legally donate large amounts of cash or other valuable goods and services to candidates' campaigns. They actually can't.

However, they *can* legally donate unlimited amounts of resources to other people, including people not connected to the campaign but who are dedicated to promoting the candidacy of a specific person. So, I can't give a million dollars to Bob the Candidate, but I can give a million dollars to the Nonprofit Corporation Dedicated to Promoting the Election of Bob (again, assuming there is not direct coordination between those two entities.)

My university has a very excellent course on drug design and discovery and we definitely learned in it that drugs are typically compared against the current standard-of-care, not a placebo. This course has weekly experts from major drug companies giving lectures, too, so it's not just some academics spouting stuff they don't know anything about.

This brings up the question of who gets to decide what "standard-of-care" and "current best treatment" are for the purposes of trials - and it comes back to the same companies that are running those trials. This creates an incentive to select an active comparator that's better than placebo but still feeble enough for the drug under investigation to compare favourably. I'm not aware of the literature on the extent that companies succumb to this temptation.

On a related note, A professor working in this field once told me about a set of trials he had read:

1) Drug A vs. Drug B2) Drug B vs. Drug C3) Drug C vs. Drug A

1) found A was better than B2) found B was better than C3) found C was better than A

Go figure. Ben Goldacre (and Ars' excellent summary here) are doing a huge service by shining a spotlight on practices that have been known about for years.

"Follow the money", and "consider the source" -- the two sayings I have learned to live by. Big Pharma, Big Agriculture, Big Science, Big Environmentalism, Big Education -- the list goes on and on. In each of these, benefits to the people are secondary (if that) to that of the providers. Each of these is governed by a restricted form of capitalism where very little feedback from consumers is allowed. For example, parents cannot get their kids a proper education without spending money over and above what they're already paying through taxes. Since medical savings accounts are severely restricted by government, people cannot get the preventive treatment they REALLY need without paying out-of-pocket because their insurance doesn't such treatment.

Most of the afflictions of today's society can be treated through proper diet, but there's no money in that. Most drugs would not be needed if the patient had been advised earlier about the REAL issues of health before the affliction had advanced too far, but there's no money in that. Medical schools should teach preventive medicine, but there's no money in that.

What's worse, the true health issues are being ignored by the various government agencies and non-profit institutions. So we're told that cholesterol control is really important, that animal fats are bad, and to eat lots of "health whole grains", while the opposite is true in all cases. So if I REALLY want to stay healthy, I have to educate myself and ignore warnings proclaimed by the USDA, FDA, ADA, and AHA. (Doctors already ignore the AMA.)

So we are saddled with top-down crony capitalism, not to be confused with bottom-up free enterprise. Until we vote for change towards the latter, it's "Caveat Emptor".

Which includes the issues of patents. Pharmaceutical companies will push doctors towards newer, more expensive, drugs that are still under their patents, even if they are actually LESS effective then an older drug with an expired patent.

they also like to patent "new" drugs that are functionally identical to their predecessors (Claritin vs Clarinex, etc) and get doctors to switch to those after the old one goes generic.

and then there's the thing where a week's worth of "prescription strength" ibuprofen costs several times more than a huge bottle of generic advil. I got a prescription for that once and the pharmacist told me to just buy the generic and take 4 at a time because it'd be cheaper than my prescription copay.

That means that the drugs that you are prescribed are usually not known to be the best treatment. Some may be, but others are, at best, better than doing nothing. Bad enough?

Full disclaimer: I haven't read the book.

I just want to point out that the truth typically lies between the two extremes. In this case the extremes are presented by pharmaceuticals/regulatory bodies and Bad Pharma. As nice as it is to see the opposite extreme presented, statements like the above always erg me for failing to consider the complexity involved with the human body and the personal, social, and cultural contextual factors involved with any given patient.

But it seems to me it attempts to cast every agency involved with drugs in an evil and nefarious light, which in my opinion is ridiculous. Sure there are a lot of problems with the industry, but pointing fingers at *everyone* and screaming criminal isn't exactly a solution. Perhaps it rattles some cages, but it puts everyone on the defensive for any proposed changes.

We are entering an age where patients can now advocate on their own behalf because a large amount of knowledge is easily accessible from the internet (thought not all trustworthy), and this may be the biggest advantage of this book--to encourage informed self-advocacy to the various medical treatments received.

This book seems to raise a lot of good points, but it could do with a little less of the extremism for me to read without throwing it at the wall.

The broader issues noted aren't simply endemic to the healthcare field. They reflect what groups of self-interested people tend to do, in similarly structured systems. They are, IMO, largely a result of of so-called "free market" solutions, meets big-money-lobbying interests, meets (private and public) political interests.

It's always easy to critique, and great to raise awareness, but what do we, practically speaking, do about it?

asoundlife wrote:

This book seems to raise a lot of good points, but it could do with a little less of the extremism for me to read without throwing it at the wall.

Yep. There is a hint of fear-mongering, at least in the way the article reads.

Chris Lee / Chris writes for Ars Technica's science section. A physicist by day and science writer by night, he specializes in quantum physics and optics. He lives and works in Eindhoven, the Netherlands.